Brief comments on four short articles from this week, on disparate topics:
James Capretta of the American Enterprise Institute (meaning he is politically right of center) pleads in the Journal of the American Medical Association (JAMA) for compromise between Republicans and Democrats on further healthcare policy reform. Arguing that the House-passed American Health Care Act (AHCA) may never pass, he believes that a better result politically and for public policy would be if legislators could, in essence, split the difference between the AHCA and current law, the Affordable Care Act (ACA, aka “Obamacare”) on some points where he sees some agreements in principle. He proposes: 1) a hybrid approach between the ACA’s income-based tax credits for health insurance purchase and the AHCA’s age-based approach; 2) ensuring continuous insurance coverage for people with pre-existing conditions by modifying the ACA’s penalties for not being insured to fall more heavily on higher-income people; 3) setting limits on the favorable tax treatment of employer-paid health insurance premiums; 4) automatically enrolling uninsured people into a bare-bones, no-premium plan from which they could opt out in favor of re-enrollment in a different plan (a proposal that sounds to me a lot like the Democrats’ “public option” with a guaranteed fight over scope of coverage); and 5) limiting Medicaid expansion to tie it to reform of the program (something that sounds to me a lot like what I understand is currently in the AHCA). Mr. Capretta knows a lot more about health policy than I, and has been at it a lot longer. His ideas seem reasonable. But he admits that bipartisan compromise “may be wishful thinking,” and I must confess that my reaction to his article is, “when pigs fly.”
The editors of Nature smile on Pope Francis’s meeting with Huntington’s disease researchers and patients. Many of the latter group, they note, are poor Venezuelan (who there is not poor—and oppressed—these days?) Catholics who greatly aided research with tissue donations “with little tangible reward.” The editors further cite the Pope’s encyclical Laudato si, with its acceptance of the existence of anthropogenic climate change, as a hopeful sign that the Catholic Church will one day use its considerable influence to compromise on “sensitive issues” such as sanctity of human life from conception, and embryo selection. Still, “there is a chasm between religion and science that cannot be bridged. For all its apparent science-friendliness, Laudato si sticks to the traditional Vatican philosophy that the scientific method cannot deliver the full truth about the world.” The editors call for “fresh dialogue” between science and religion—by which they mean capitulation of the latter to the flawed-on-its-face epistemology of the naturalist. I’m not buying.
Another provocative piece in JAMA tackles ethical concerns about drug company marketing of treatments for rare diseases. The specific concern is “disease awareness” campaigns. The authors cite a collaboration between Incyte, the manufacturer of the only FDA-approved treatment for a rare disease (there are older, “grandfathered,” treatments of modest effectiveness), and the producers of the soap opera General Hospital, in which a character has said rare disease and (not quite like Huey Lewis) wants a new drug. The authors ask: Is disease awareness marketing in disguise? Do disease awareness campaigns promote sales of specific drugs? Does awareness of rare diseases really help, when, unlike common diseases, more aware people can get effective treatment at an earlier point in the disease history, but with rare diseases, they might only be overdiagnosed, overtested, and overtreated. Hmmm. The authors allow that the courts have protected direct-to-consumer drug advertising as free speech, but assert a duty of the medical profession to ensure that information to the public is not only true in a narrow sense but also not misleading. They conclude with a bit of an overreach: “[D]irect-to-consumer advertising is a massive medical intervention with unproven public health benefit, dubious plausibility, and suggestive evidence of harm.” The suggestion is that “disease awareness” campaigns ought to be regulated by the FDA. I have to say I’d find it amusing, to say the least, for the FDA to be regulating soap operas—a candidate for Mad magazine’s “Scenes We’d Like to See.”
Wesley Smith blogs that Ontario is moving toward creating mandatory policies regarding assisted suicide that have the strong possibility, if not likelihood or certainty, that doctors will be required to help provide aid in dying or refer “in good faith” to other doctors who will—essentially steamrolling any conscience exemptions. He sees in this a deliberate, tyrannical program to destroy the soul of medicine, extinguish thoughts of the sanctity of life, and cleanse the medical profession of religious or Hippocratic practitioners. So do I. Follow the link and read his post.